MAPPING ACCESS DESERTS: A GEOSPATIAL ASSESSMENT OF SOCIOECONOMIC DISPARITIES IN THE UNITED STATES DLBCL CAR-T THERAPY NETWORK
Author(s)
Salome Ricci, MS, PharmD1, Alison Duffy, PharmD1, Eberechukwu Onukwugha, MSc, PhD1, Juan-David Rueda, MS, PhD, MD2, Jean A. Yared, MD3, Julia F. Slejko, PhD1;
1University of Maryland School of Pharmacy, Department of Practice, Sciences, and Health Outcomes Research, Baltimore, MD, USA, 2AstraZeneca, Gaithersburg, MD, USA, 3University of Maryland School of Medicine, Baltimore, MD, USA
1University of Maryland School of Pharmacy, Department of Practice, Sciences, and Health Outcomes Research, Baltimore, MD, USA, 2AstraZeneca, Gaithersburg, MD, USA, 3University of Maryland School of Medicine, Baltimore, MD, USA
OBJECTIVES: Chimeric Antigen Receptor T-cell (CAR-T) therapy offers curative potential for relapsed/refractory diffuse large B-cell lymphoma (DLBCL); however, administration is limited to certified centers, potentially creating geographic barriers to access. The extent of socio-spatial disparities in access to the evolving treatment network remains poorly characterized. This study mapped geographic access to CAR-T centers for DLBCL in 2025 across the contiguous United States (US) and evaluated the association between travel burden and county-level social vulnerability.
METHODS: We conducted a cross-sectional geospatial network analysis. The network included 169 manufacturer-listed authorized treatment centers for Yescarta, Kymriah, and/or Breyanzi. Using 2020 US Census population centroids for 3,108 counties to proxy geographic distribution of patient residence and potential utilization, ArcGIS Pro Network Analyst calculated driving time to the nearest center for each county. Counties were classified by driving time (<60 vs. ≥60 minutes), reflecting common CAR-T program proximity requirements. Socioeconomic vulnerability was measured using the CDC Social Vulnerability Index (SVI 2020). We employed bivariate choropleth mapping to identify "double burden" regions characterized by high driving time (≥60 minutes) and high social vulnerability (SVI≥0.66), i.e., ‘high-vulnerability access deserts’.
RESULTS: Seventy percent (229 million) of the population resides within 60 minutes of a center, while 30% (99 million) face driving times exceeding 60 minutes. Bivariate analysis identified a substantial "double burden" population: forty-four million (13%) individuals reside in high-vulnerability access deserts, a population more than twice as large (20 million) as the low-vulnerability residents (SVI<0.33) living in access deserts.
CONCLUSIONS: The 2025 US CAR-T network includes a substantial catchment population living in areas characterized by significant travel burdens and socioeconomic vulnerability. This "double burden" highlights a misalignment between network capacity and vulnerability, suggesting that the current configuration reinforces existing socioeconomic disparities. Policy interventions must be geographically targeted to these identified high-vulnerability regions to ensure equitable delivery of curative therapies.
METHODS: We conducted a cross-sectional geospatial network analysis. The network included 169 manufacturer-listed authorized treatment centers for Yescarta, Kymriah, and/or Breyanzi. Using 2020 US Census population centroids for 3,108 counties to proxy geographic distribution of patient residence and potential utilization, ArcGIS Pro Network Analyst calculated driving time to the nearest center for each county. Counties were classified by driving time (<60 vs. ≥60 minutes), reflecting common CAR-T program proximity requirements. Socioeconomic vulnerability was measured using the CDC Social Vulnerability Index (SVI 2020). We employed bivariate choropleth mapping to identify "double burden" regions characterized by high driving time (≥60 minutes) and high social vulnerability (SVI≥0.66), i.e., ‘high-vulnerability access deserts’.
RESULTS: Seventy percent (229 million) of the population resides within 60 minutes of a center, while 30% (99 million) face driving times exceeding 60 minutes. Bivariate analysis identified a substantial "double burden" population: forty-four million (13%) individuals reside in high-vulnerability access deserts, a population more than twice as large (20 million) as the low-vulnerability residents (SVI<0.33) living in access deserts.
CONCLUSIONS: The 2025 US CAR-T network includes a substantial catchment population living in areas characterized by significant travel burdens and socioeconomic vulnerability. This "double burden" highlights a misalignment between network capacity and vulnerability, suggesting that the current configuration reinforces existing socioeconomic disparities. Policy interventions must be geographically targeted to these identified high-vulnerability regions to ensure equitable delivery of curative therapies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
P43
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity, Reimbursement & Access Policy
Disease
SDC: Oncology